Parents want to encourage daughter Tramadol long-term not for everyone Restore yourself with rest, Pisces

Dear Amy: Our youngest daughter began competitive dance at four, started acting and singing at 14 and graduated from college with a degree in musical theater. Her goal is to be on Broadway.

She is very talented and outworks everyone. She is also very sensitive. It is hard on her when she doesn’t get hired after an audition.

My wife and I totally support her decision to work in this field, but how should we help her deal with her success and failures? — Supportive Parents

Dear Parents: My own advice to you parents is that you insist that your daughter should work. She should look for temp or restaurant jobs that will accommodate her acting classes and auditions. Working will keep her grounded and busy — and connected to other young actors and artists. She will need to learn to manage her reactions to rejection.

I have shared your question with Quinn Cummings, former actress and current author of the wonderful memoir: “Notes from the Underwire: Adventures from My Awkward and Lovely Life,” (2009, Hyperion).

She responds: “The life of the artist is hard. The life of the actor is harder still. You love to paint, you can always paint, whether anyone wants your work. Acting requires an audience.

“The only way to prevail over this kind of life — which can easily exhaust and destroy shining, sensitive souls — is to find ways to create that kind of joy on your own.

“Create a character, write minute-long scenes, and put them on Instagram. Get a group of like-minded people together, decide to act out old episodes of your favorite sitcom in the back room of a bar.

“That way, if the casting director is hateful, or no one even looks up during your audition, you can walk out thinking not about the pain, but about the hilarious character you are going to create from this.”

Dear Dr. Roach: I just read your column regarding concerns about taking tramadol long term for arthritis pain. I am a 74-year-old female, and I take one or two 50-mg tablets a day, depending on my pain level. Most days, my pain is controlled on that dose. I also take 1,300-mg acetaminophen twice daily. I have chronic atrial fibrillation, and take Coumadin daily. I have been taking tramadol for over a year. I have been on other pain medications in the past, but my doctor didn’t want me to stay on them long term. What are my options? — N.P.

Opiates like tramadol are useful pain medications for acute pain, but they are not appropriate for many people with chronic pain. They have side effects and can be misused, and people tend to develop a tolerance for them, which means that they really don’t work very well; people report the same amount of pain despite long-term use, compared with when they weren’t taking them. Given the large amount of overdose with these drugs, deliberate and accidental, it is entirely appropriate to limit opiate use to a few days in those with acute pain and to consider whether any patient needs them long term.

There is another side to the story, however. Some people do well on opiates, taking reasonable doses that remain stable. There also are people for whom there are no other good medication options, such as people with extremely painful facial nerve pain syndromes. Policies that are intended to reduce harm from opiates need to consider the group of people for whom they are appropriate, and who may be harmed by restrictive policies.

In your situation, given the low dose of tramadol you have been taking for a year, and the (what sounds like) adequate control on this dose, I would not feel strongly that you needed to change.

Today’s Birthday: Listen to your heart this year. Maintain cash flow momentum with steady input. Discover insights into your work and health.

Sagittarius (Nov. 22-Dec. 21) (7) An exploration takes flight. All your connections are coming together. Find ways to economize.

Capricorn (Dec. 22-Jan. 19) (8) Take care of business with shared accounts. Keep your part of the bargain. Complete a job early and under budget.

Aquarius (Jan. 20-Feb. 18) (8) Together, you and a partner can advance beyond expectation. Avoid misunderstandings by communicating.

Pisces (Feb. 19-March 20) (8) Demand for your work is rising. Guard your physical energy. Restore it with exercise, good food and sleep.

Aries (March 21-April 19) (8) Talk about love. Express your heart. Practice your arts and talents. Action gets farther than anticipated.

Taurus (April 20-May 20) (8) Family conversations lead to practical ideas for home upgrades. A renovation provides lasting value. Try something new.

Gemini (May 21-June 20) (8) Monitor channels of communication. Listen, and provide someone a valuable service.

Cancer (June 21-July 22) (9) Count your winnings. Your income rises with positive conditions. Take advantage of rising sales or business.

Leo (July 23-Aug. 22) (9) Practice for a powerful performance. Get help with any heavy lifting. Share acknowledgment and gratitude.

Virgo (Aug. 23-Sept. 22) (7) Find an answer in a dream. Insight strikes unbidden. A stroke of genius reveals new options.

Libra (Sept. 23-Oct. 22) (8) Talk with friends to advance a group project. Community efforts can take big ground.

Scorpio (Oct. 23-Nov. 21) (8) Conversation can lead to a career opportunity. Put in extra effort, and continue earning respect. There’s more work available.